MEDICARE: MR. SAMUEL CHOI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1497208094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL CHOI DPT

Provider Business Mailing Address
First Line	:	223 13TH ST
Second Line	:	18
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4832
Country	:	US
Telephone Number	:	203-530-1561
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 7TH AVE
Second Line	:	2A
City	:	BROOKLYN
State	:	NY
Zip	:	11215-7247
Country	:	US
Telephone Number	:	718-619-4773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	07/29/2016

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